In Billing
Feb 16th, 2016
A final rule, issued by the Centers for Medicare & Medicaid Services (CMS) on Feb. 12, clarifies reporting and repayment obligations for providers and suppliers who receive a Medicare overpayment. The final rule explains, “a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the ...
Jan 26th, 2016
Two recent cases from Georgia demonstrate that organizations must not ignore—and certainly shouldn’t fire (as a knee-jerk reaction)—employees who raise compliance concerns and who are protected by the False Claims Act (FCA). In one case, HCA Holdings, Inc., (HCA) the largest operator of healthcare facilities in the United States, entered into an agreement with the ...
Under the False Claims Act (FCA), a healthcare facility or entity may be held liable for the conduct of its individual employees, or even the conduct of other entities with which the healthcare facility or entity contracts or associates. This is true even where the healthcare facility or group practice entity has no actual knowledge ...
In Audit
Nov 15th, 2012
If you receive a letter from a Medicare recovery audit contractor (RAC) regarding overpayment, don’t panic! You may think you only have two options: pay up or launch an appeal. There is another option, however, if you move fast (before a formal appeals process starts) and are certain the RAC is mistaken about the overpayments. ...
Oct 1st, 2012
By Mary A. Inman, JD, and Timothy P. McCormack, JD As Medicare-managed care health plans (Medicare Advantage (MA) plans) expand—especially in the past five years—providers are more regularly affected by “risk adjustment.” When done properly, the risk adjustment model has great potential to enhance the quality of patient care. Unfortunately, risk adjustment is also susceptible ...